Network Adequacy Lead – State & CMS Compliance

Georgia Department of Revenue; Atlanta (GA); On-site; USD 75,000 - 100,000; Full time

Job summary

The Insurance Department of the State of Georgia seeks a Network Adequacy Manager to oversee compliance with federal and state network adequacy standards for QHP and off‑Exchange ACA plans.

Under supervision, you will supervise analysts and vendors, coordinate with CMS/NAIC, review issuer network submissions, and prepare quarterly and annual adequacy analyses for leadership.

Bachelor’s degree with 3+ years in management or 7+ years in the field is required; prior regulatory experience is a plus.

Qualifications

• Bachelor’s degree in a related field from an accredited college or university and three (3) years in a managerial role; or seven (7) years of experience in the area of assignment, including three (3) years in a managerial role; or one (1) year of experience required at the lower level Mgr 2, Regulatory Compliance (RCM051) or position equivalent.

Responsibilities

• Oversee analytical activities and supervise staff and vendor partners.
• Ensure timely and accurate review cycles and provide updates to leadership.
• Maintain expert knowledge of Georgia network adequacy requirements and CMS standards.
• Serve as the SME on federal and state network adequacy regulations and performance metrics.
• Coordinate with CMS, NAIC, and external consultants to ensure alignment and timely certification review cycles.
• Draft issuer correspondence regarding deficiency notices and corrective action requirements.
• Establish annual QHP certification timelines for adequacy submission review.

Skills

Managerial experience

Education

Bachelor’s degree in a related field

Job description

The Insurance Department of the State of Georgia seeks a Network Adequacy Manager to oversee compliance with federal and state network adequacy standards for QHP and off‑Exchange ACA plans.

Under supervision, you will supervise analysts and vendors, coordinate with CMS/NAIC, review issuer network submissions, and prepare quarterly and annual adequacy analyses for leadership.

Bachelor’s degree with 3+ years in management or 7+ years in the field is required; prior regulatory experience is a plus.